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				<p style="font-size:14; font-weight:bold;">EMERGENCY FORM</p>
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			<td style="width:50;" class="underline">&nbsp;</td><td>Old Student</td>
			<td style="width:50;" class="underline">&nbsp;</td><td>New Student</td>
			<td style="width:50;" class="underline">&nbsp;</td><td>Level AIC Reg</td>
			<td style="width:50;" class="underline">&nbsp;</td><td>Class Time</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Name of Child:</td><td style="width:245;" class="underline">&nbsp;</td>
			<td>Nickname:</td><td style="width:150;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Date of Birth:</td><td style="width:260;" class="underline">&nbsp;</td>
			<td>Age:</td><td style="width:180;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Home Address:</td><td style="width:250;" class="underline">&nbsp;</td>
			<td>Tel. No.</td><td style="width:160;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Name of Father: </td><td style="width:245;" class="underline">&nbsp;</td>
			<td>Mother: </td><td style="width:165;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Business Address: </td><td style="width:230px;" class="underline">&nbsp;</td>
			<td style="width:45;">&nbsp;</td><td style="width:165;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Tel. No. </td><td style="width:280;" class="underline">&nbsp;</td>
			<td style="width:45;">&nbsp;</td><td style="width:165;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Guardian:</td><td style="width:275;" class="underline">&nbsp;</td>
			<td style="width:45;">Tel. No.</td><td style="width:165;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Physician:</td><td style="width:275;" class="underline">&nbsp;</td>
			<td style="width:45;">Tel. No.</td><td style="width:165;" class="underline">&nbsp;</td>
			<td style="width:100;">&nbsp;</td>
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			<td>Blood type od a child:</td><td style="width:210;" class="underline">&nbsp;</td>
			<td style="width:310;">&nbsp;</td>
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			<td>Is the child suffering from any ailment?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td style="width:250;" class="underline">&nbsp;</td><td style="width:100;">&nbsp;</td>
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			<td>If yes, what precautionary measures do we take?</td><td style="width:270;" class="underline">&nbsp;</td><td style="width:100;">&nbsp;</td>
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			<td>Any allergies to medicine?</td><td style="width:20;" class="all_around">&nbsp;</td><td>No</td><td style="width:20;" class="all_around">&nbsp;</td><td>Yes</td><td>What?</td><td style="width:240;" class="underline">&nbsp;</td><td style="width:100;">&nbsp;</td>
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			<td>Person authorized to pick up the child?</td><td style="width:320;" class="underline">&nbsp;</td><td style="width:100;">&nbsp;</td>
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